LVHN acting CEO: It's about value, the patient

Lehigh Valley Health Network is faced with the task of finding the right person to follow Dr. Ronald Swinfard, the network's outgoing president and CEO and one of the pioneers of the newly created AllSpire health network consortium.

Earlier this month, Swinfard delivered an unexpected retirement resignation to LVHN's board of directors. With a backup succession plan in place, the board called upon LVHN's chief strategy officer, Dr. Brian Nester, who has been with the network since 1998.

Nester, a Reading native, will assume the role of acting president and CEO on July 1, and he is one of the candidates for the permanent job to lead a network that has more than 12,000 employees and four hospitals and 11 health care centers throughout the Greater Lehigh Valley.

Besides adapting to changes caused by the Affordable Care Act and the ever-changing health care landscape, LVHN is developing a working relationship with six other health networks as part of AllSpire Health Partners. The consortium was formed last year to provide cost-effective and efficient health care.

LVHN has launched a national search for a permanent president and CEO, which may also include other internal candidates besides Nester. But in being named acting president and CEO, Nester was empowered by LVHN's board to make decisions, and not just be a caretaker.

In an exclusive interview with Lehigh Valley Business, the 52-year-old Nester talked about the transition at LVHN, health care challenges and his background and aspirations – including the move to fee-for-value vs. fee-for-service.

What were some of your roles and achievements throughout your tenure with LVHN?

Nester: I was director of the emergency department at Muhlenberg [LVH-Muhlenberg Hospital in Bethlehem]; associate vice chair of the overall emergency department for LVHN; research program director; and director of medical education for the Muhlenberg campus. There were some others [roles] along the way, but those are the big ones.

Early on, the biggest accomplishments, there were three, and they were all about patient care and improving care delivery.

In about 2000, we consolidated psychiatric beds across the Valley, literally, from other institutions as well, and we built the behavioral health and science 60-bed facility at Muhlenberg. …We worked with our chair of psychiatry, Dr. [Michael] Kaufmann, and created an emergency behavioral health unit … for acute psychiatric illness, right adjacent to the emergency department, and it's become a national model.

And what's really wonderful is to see that many folks that have challenges that sometimes require chemical restraints, physical restraints … we dropped our physical restraints to the lowest levels we had ever had. So that was big. It was huge.

The other one [accomplishment] is Muhlenberg's volume had dropped down to about 24,000 patient visits per year. At a high they were at 31,000 or 32,000, and we reversed that and now within about four years we are back up to 30,000 again.

The last one [accomplishment] was starting the residency program.

Tell me more about your background before LVHN, and how your experience might fit into this role?

Nester: I was assistant director of an emergency department down in Delaware County, called Delaware County Memorial Hospital. It was working for a very busy, for-profit emergency medicine firm. I did a lot of clinical work so I was a real kind of ER doc for several years and then came back to [Albert] Einstein [Medical Center in Philadelphia] to be academic faculty and get back to some research … and worked at a major trauma center in Philadelphia and loved it.

I became very academic, did a lot of teaching, and got a master's degree … and I really wanted to bring good things to life, so as Ron [Swinfard] would say, “many of us who are here, we escaped academics.” … This is a wonderful environment and we enjoy the academic stuff, the teaching stuff … but when we get to the bedside, we really do things. …

How did that help me? I was a grounded clinician first and I had a passion for that, so when I brought that to Muhlenberg and I was passionate about the delivery of care, access, improving patient service, customer satisfaction, I became the go-to person at Muhlenberg for all patient complaints in the community, many of which revolve around the emergency department…

Halfway through [MBA school], Elliot Sussman [then the president and CEO of LVHN] came to me and said “Hey, you're involved in a lot of this business stuff and physician interaction and working with consumers and patients. Look, I think we need someone to do this work and there's a role that you could apply for.”

And it was the senior vice president role for physician practice and network development, to grow the business, work with the doctors, improve service and just make sure we grow volume. So, I got that job.

Upon taking the acting role as president and CEO, what has the LVHN board of directors instructed you to do?

Nester: First is, there is specificity to the title. It's acting, not interim, because it's unexpected [Swinfard's retirement]. There is a rationale behind that.

[The board of directors at LVHN said] “You've been here a long time. You know the people. You've worked well with Ron [Swinfard] and Elliot Sussman. We don't want this to be a holding position. We don't want you to be a caretaker until we find the ultimate, permanent leader. We want this to be an acting role, because we want you to act,” which I am thrilled about because I think we should and we can.

What are your plans for the network, if you land the permanent role of president and CEO?

Nester: I think they are the same as what they are today, aspirationally. We are in a tough, tough business right now, and we have a huge commitment to the community.

No. 1, we are the largest employer in the marketplace, and we have fabulous, fabulous inpatient assets. I have been across the country to many different places. This is about as nice of an environment to practice acute care inpatient medicine.

The reality is that fee for service has really driven a lot of that and has rewarded us for that.

With value-based purchasing, that is turned on its end. It is all about appropriate utilization of those inpatient services, but more about engaging patients in their health, their wellness, their pursuit of better care and keeping them out of “expensive assets” of the inpatient environment. And I am absolutely certain that we can do that.

So that's moving from that fee-for-service to fee-for-value world.

So, I think aspirationally, we are trying to re-engineer our hospital and health system into a new kind of health care company that is capable of truly managing populations, taking on clinical and financial risk, because that's going to be the way of the world.

And here's the good news: It's good for patients.

It will be hard for us to change, because we are not going to get paid to do it, and we are struggling through that right now. Our acute inpatient business is down 4 percent. That has historically been one that has paid our bills.

The reality is that's not going to work anymore.

Our revenue probably will proportionately shrink, and a good portion of it will be at risk for our performance, which, by the way, is how it should be. There is a lot of money in this [health] system. I think there is plenty of money in it to go around, to take care of patients …

Are there any initiatives that you would like to see implemented?

Nester: We have a lot of them that go under the radar. … There are no new ones but some that people don't know about. …

Getting economies of scale through mergers … all that does is largely get you group purchasing to buy stuff cheaper in bulk. That doesn't fix our problems. So, that's why we started AllSpire. We are finding ways through our intellectual strengths and our buying strengths to accelerate this movement from a fee-for-service world to fee-for-value world, and we are finding many ways to do that…

Have you met with the other CEOs of AllSpire?

Nester: I was involved at the front end of pulling AllSpire together, with Ron [Swinfard].

I met with all the original stakeholders and I know all of the CEOs quite well, and was with all of them last Monday … and I am on the development committee for AllSpire …

In the clinical world, it's not just about taking care of business, it's about taking care of the patient. Taking better care of patients can actually lower costs...

Will this transition process be an opportunity for LVHN to look at its mission and goals, and potentially tweak or revamp them?

Nester: Our mission is to heal, comfort and care for the people of our community by providing advanced and compassionate care, superior quality and value. … It's always been value at the end, so I am having a hard time seeing how we necessarily have to change the mission.

I think we can redirect our focus on that to really go after value. Value has not been prioritized. … Hamster-wheel transactionalism is what was rewarded, and that results in, frankly for the whole industry, some perverse incentives financially.

So, I think fee-for-service drives us to do things that aren't the best use of funds, across the industry.

I think we have been wonderful stewards for our community, no doubt, but I think we are excited about…value-based purchasing, because that is going to separate us from the other providers.

If you believe in value – by the way, nobody can't believe in value production – it's higher quality care at a lower cost. How do you argue that? And we are not for profit, and with that mission. If you believe in that, then get on the horse. Get into it, know what it's going to take to do it, invest in the infrastructure. … Let's get going. …

By the way, the world is happening fast around us. Consumers of health care are getting it in their pocket right now. The economy is not hot. The burden of health care is going more to the individual.

I believe exchanges will flourish, price sensitivity will reign, and when that happens, you have a very informed consumer and they are going to know who can provide the best quality at the lowest cost.

And that's the journey we are on, because we think we can succeed there.

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Jennifer Glose

Reporter Jennifer Glose covers health care, Berks County and other topics. She can be reached at jenniferg@lvb.com or 610-807-9619, ext. 111. Follow her on Twitter @jenniferg_LVB and read her blog, “Networking,” at http://www.lvb.com/section/networking-blog.

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